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General NPI Number Information
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NPI Number | 1528272721
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Entity Type | Organization
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Legal Business Name | GERALD B. LEIBER, D.M.D., P.C.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 0 GOVERNORS AVE SUITE 30
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City | MEDFORD
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State | MA
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Zip | 02155-3025
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Country | US
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Telephone | 781-391-5100
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Fax | 781-391-4833
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Provider Business Mailing Address
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Address Line | 0 GOVERNORS AVE SUITE 30
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City | MEDFORD
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State | MA
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Zip | 02155-3025
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Country | US
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Telephone | 781-391-5100
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Fax | 781-391-4833
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GERALD B. LEIBER
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Credential | D.M.D.
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Telephone | 781-391-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 12008
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License Number State | MA
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